title: Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers.
abstract: BACKGROUND
  Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA.
  
  
  OBJECTIVE
  This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services.
  
  
  METHODS
  This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature.
  
  
  RESULTS
  This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems.
  
  
  CONCLUSIONS
  Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations.
authors.affiliation: Telfer School of Management/École de Gestion Telfer, University of Ottawa/Université d'Ottawa, 5141 Desmarais Building, 55 Laurier East, Ottawa, ON K1N 6N5 Canada.
authors.forename: Denis H J
authors.initials: DH
authors.lastname: Caro